Sexual dysfunction disorders are problems that interfere with the initiation, consummation, or satisfaction with sex. They occur in both men and women and are independent of sexual orientation.
Probably nowhere in human health do the body and mind interact more than during sex. There are four generally recognized phases of sexual activity, involving both mental and physical responses and are applicable to both men and women. These phases are in sequence:
- desire or appetite—fantasies or thoughts about sex.
- excitement—physical changes to prepare the body for intercourse and accompanying sense of sexual pleasure
- orgasm—physical response that leads to the peak of physical pleasure and release of sexual tension
- resolution—physical relaxation accompanied by a feeling of well-being and satisfaction
Sexual dysfunction disorders can occur in any of these four phases. Their cause may be physiological or psychological. More than one sexual dysfunction disorder may appear simultaneously. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR), produced by the American Psychiatric Association and used by most mental health professionals in North America and Europe to diagnose mental disorders, recognizes nine specific sexual dysfunctions:
- Disorders of desire: These interfere with the initiation of sex and include hypoactive sexual desire disorder (low interest in sex) and sexual aversion disorder (objections to having the genitals touched).
- Disorders of excitement or sexual arousal: These are female sexual arousal disorder (when a woman fails to have physiological responses associated with arousal), and male erectile disorder (when a man fails to get an adequate erection, also referred to as “erectile dysfunction”).
- Disorders of the orgasm phase: These are female orgasmic disorder (when a woman fails to reach orgasm); and male orgasmic disorder (when a man fails to reach orgasm) and premature ejaculation (when a man reaches orgasm too soon).
- Sexual pain disorders (associated with intercourse and orgasm): These disorders are vaginismus (the outer part of a woman’s vagina spasms causing pain) and dyspareunia (pain during intercourse in either men or women).
In addition, medications or illicit drugs may cause substance-induced sexual dysfunction and sexual dysfunction may be caused by a general medical condition such as diabetes or nerve damage. If the sexual dysfunction falls into none of the above areas, it is classified as sexual dysfunction not otherwise specified.
The causes of sexual dysfunction disorders are varied, as are their symptoms. In general, symptoms either prevent the initiation of sex or the completion of the sex act, or they interfere with satisfaction derived from sex. Almost everyone has some problem with sexual functioning or fulfillment at some point in their lives, but not all problems are considered sexual dysfunction disorders. Sexual satisfaction is very personal and individual, so that what may be an annoyance for one couple may be a serious problem for another. However, estimates suggest that roughly one-fourth of the adult population may have a sexual dysfunction disorder. More women than men report having sexual dysfunction disorders, but the difference may be that women are more open and active about seeking help with sexual problems than are men.
Diagnosis begins with a sexual and medical history, and often a physical examination and laboratory tests. Treatment must be individualized based on the cause and the specific dysfunction and includes physiological treatment, psychotherapy, and education and communication counseling. Most people can be helped to resolve their problems and improve their sex life. Generally, the sooner the person receives help, the easier the problem is to resolve. Support of a partner is often critical to successful resolution of the problem.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revised. Washington DC: American Psychiatric Association, 2000.
Hales, Robert E., Stuart C. Yudofsky, and John A. Talbot. The American Psychiatric Press Textbook of Psychiatry. 3rd ed. Washington, DC: American Psychiatric Press, 2000.
Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.
Tish Davidson, A.M.